WP: CBO says health care repeal would deepen deficit

[PeterMP]

LOL I think I would know a little something about multivariate analysis considering I have had to take oh I don't know maybe 5 classes on it. It is a foundation for any cross-national analysis however I do not think you know what it really is. Why in the world would a multivariate regression analysis not apply to a cross-national comparison in health?

It would. It hasn't been the basis of a single study or anything that anybody has commented on with respect to the US health care as compared to any other health care system in the world.

The comparisions you and JMS are referring to are DO NOT use multi-variate statistics.

Once again you are stating falsehoods. The other countries don't say no????? What are you talking about? Do yourself a favor and look up what NICE does in the British NHS. It REGULARLY denies people procedures. I find it funny that you would state that they do not say no when one of the main oppositions of universal systems is that they say no too often.

Are you bothering to read the posts: "At least not enough or there wouldn't be having the problems that they are."

I'm not most people.

You are right that government pays for the poorest of the poor that cannot pay for their premiums, but the US already does that with Medicare so this point is moot. Nobody said non-profits are illegal they are just not the norm. Under this system for-profits become illegal.

Okay so if they aren't illegal (and they are really superior), then the companies and individuals looking for health care should resort to using them, and the profits should go out of business.

I cannot post any of these studies since I have them as PDFs on my computer or they are books that I own. However, like I stated earlier if you PM me your email I will be more than happy to email them to you.

They don't exist as on the web?

[shk75]

It would. It hasn't been the basis of a single study or anything that anybody has commented on with respect to the US health care as compared to any other health care system in the world.

The comparisions you and JMS are referring to are DO NOT use multi-variate statistics.

Are you bothering to read the posts: "At least not enough or there wouldn't be having the problems that they are."

Of course we are not using multivariate analysis, first they are complicated and take time to create and you cannot make one up on the spot. Second the studies I have quoted regularly use them to arrive at their conclusions. You ask if they are on the web, the answer is yes and no. They are on a site called pubmed which costs money to subscribe too. My school pays for me to use it so unless you are a member of pubmed you will not be able to access them and you cannot find them using google. They are studies from academic journals like the Lancet, Health Affairs and Policy, etc. Like I said if you would like access to a specific study I would be more than happy to email it to you but I am not going to post a 25 page PDF as text format in the forums.

At least not enough says who? There is not fact behind your statement. In fact in Britain and Japan they say no TOO much and need to increase their spending as a portion of GDP in order to improve care. You cannot just assume that they are not saying no enough because it varies country by country.

The health insurance regulations are extremely complicated and I can go more in depth if you would like but the reason people do not use non-profit health insurers is because they are hard to find, do not cover many costs, and are not provided to them by many employers.

[PeterMP]

Of course we are not using multivariate analysis, first they are complicated and take time to create and you cannot make one up on the spot.

So nobody has tried to compare health results between countries using multi-variate statistics.

Second the studies I have quoted regularly use them to arrive at their conclusions. You ask if they are on the web, the answer is yes and no. They are on a site called pubmed which costs money to subscribe too. My school pays for me to use it so unless you are a member of pubmed you will not be able to access them and you cannot find them using google. They are studies from academic journals like the Lancet, Health Affairs and Policy, etc.

Pubmed is actually run by the goverment and is free for anybody to use (there are other indexing databases like ISI Web of Knowledge where you have to pay to even search). From there, whether you can access the paper or can just read the abstract depends on a few things and might require a subscription. And trust me, I can get anything you can get.

At least not enough says who? There is not fact behind your statement. In fact in Britain and Japan they say no TOO much and need to increase their spending as a portion of GDP in order to improve care. You cannot just assume that they are not saying no enough because it varies country by country.

Is there any case where costs aren't going up faster than inflation?

If not, then they aren't saying no enough, unless you are going to argue that indefinite increases in health care faster than inflation is some how sustainable.

(I honestly don't know anything about the Japanese healthcare system, but I actually could see them holding the line, but I think there is plenty of evidence based on the existing goverment health care system in the US that we wouldn't.)

The health insurance regulations are extremely complicated and I can go more in depth if you would like but the reason people do not use non-profit health insurers is because they are hard to find, do not cover many costs, and are not provided to them by many employers.

So they aren't as good as the for profits one?

[shk75]

So nobody has tried to compare health results between countries using multi-variate statistics.

Pubmed is actually run by the goverment and is free for anybody to use (there are other indexing databases like ISI Web of Knowledge where you have to pay to even search). From there, whether you can access the paper or can just read the abstract depends on a few things and might require a subscription. And trust me, I can get anything you can get.

Is there any case where costs aren't going up faster than inflation?

If not, then they aren't saying no enough, unless you are going to argue that indefinite increases in health care faster than inflation is some how sustainable.

So they aren't as good as the for profits one?

Yes many have tried to compare health results this way and I will cite them for you tomorrow as I am going to bed right now. You are right that you can access pubmed just not the articles unless they are free, which most are not but if like you say you have access to them then I will just cite them and you can find them.

Health care costs as a percentage of GDP are rising in all nations but they are rising faster in the US. Many believe this is because these nations do say no, and while you probably feel they could say no more, their growth rates are still slower than ours. Also health care can act like any other good and increase faster then inflation for a point until the market stabilizes and reaches a new equilibrium point. It does not mean that growth higher than inflation is unsustainable although it is worrisome if there is no end in sight.

http://www.kff.org/insurance/snapshot/chcm010307oth.cfm

Non-profit insurance not being good is not the right word. Blue cross blue shield started as non-profit but became for-profit and that shift really signaled a change in the US health insurance industry. You will be hard-pressed to find a non-profit insurance plan through your employer so what do you do? Also the way that insurance plans work is that they enter into contracts with providers. The more customers an insurance company has the more likely the provider will enter into a contract with them because it increases the amount of patients they have access too. This the larger insurance companies have negotiated lower fees with the providers in exchange for the provider to have access to more people. The smaller non-profits do not have this purchasing power and thus their subscribers often do not have access to the same quality of care, their options are much more limited.

[PeterMP]

Yes many have tried to compare health results this way and I will cite them for you tomorrow as I am going to bed right now. You are right that you can access pubmed just not the articles unless they are free, which most are not but if like you say you have access to them then I will just cite them and you can find them.

Health care costs as a percentage of GDP are rising in all nations but they are rising faster in the US. Many believe this is because these nations do say no, and while you probably feel they could say no more, their growth rates are still slower than ours. Also health care can act like any other good and increase faster then inflation for a point until the market stabilizes and reaches a new equilibrium point. It does not mean that growth higher than inflation is unsustainable although it is worrisome if there is no end in sight.

But health care has been increasing faster than inflation for an extended period of time, yes?

Nobody really believes that health care costs will stop rising faster than inflation w/o some limits (e.g. government saying no), right?

If we assume all of the different health care systems are currently in a transition until they reach a new equilibrium point, there is no a priori reason to believe that one approach will more quickly reach an equilibrium or reach a more stable equilibrium.

That, I think is your underlying problem that you and JMS (and many others) have. The assumption is their approach long term is better. However, as I stated above, if you study complex systems, then it isn't uncommon for at some point time what appear to be the more stable systems actually turn out to be the ones that fail the quickest. The appearant (but misleading) stabiliyt reduces (and misdirects) the "search" for a truely stable state if reaching that seemingly safer state includes a step that is highly likely to be irreversible.

I do want to point out that I'm not overly defending our health care system. I don't want to get into a big debate about how bad our health care system is. It is fatally flawed. My only point in that respect is that a lot of people ignore the fact that we do somethings very well, and your lists of all of the places we are at the bottom with no mention of where we were at the top, and world wide recognized medical experts and care (even when the economic component is taken into account) like that offered in the Mayo Clinic are an example of that.

There are things that work in our health care system, and it might make more sense to ask how to extend those things that work through out our current system. This will likely result in the exploration of a different "space" of health care systems then many other countries. As part of that search, we might uncover different "solutions" (keeping in mind there is no reason to believe that the European solutions are really long term solutions) to problems then those being found in countries that have European-like health care systems, and if we don't find a stable system and one of the other countries do, then we can alter our system accordingly.

I don't think the European-like system though is a real solution given the searching (through time and country) that has been done searching that local area of space without finding a real solution. If the real solution was in that direction, one of the countries searching that area would have found it (especially when you keep in mind they likely aren't seeing the real costs of their medical care because we are paying a disproportionate part of the costs related to innovation and new technology (even if the technology is developed there, the idea that it can be sold on the US market was an underlying financial incentive for the investment)).

[shk75]

But health care has been increasing faster than inflation for an extended period of time, yes?

Nobody really believes that health care costs will stop rising faster than inflation w/o some limits (e.g. government saying no), right?

If we assume all of the different health care systems are currently in a transition until they reach a new equilibrium point, there is no a priori reason to believe that one approach will more quickly reach an equilibrium or reach a more stable equilibrium.

That, I think is your underlying problem that you and JMS (and many others have). The assumption is their approach long term is better. However, as I stated above, if you study complex systems, then it isn't uncommon for at some point time what appear to be the more stable systems actually turn out to be the ones that fail the quickest. The appearant (but misleading stability) reduces (and misdirects) the search for a truely stable state if reaching that seemingly safer state includes a step that is highly likely to be irreversible.

Yes health care has been increasing with inflation for around 2-3 decades now. This can be attributed to people's increased income, (with increase income comes a higher rate of spending on health), People getting older all over the world (older people require more care), and a boom in technology and pharmaceuticals.

http://www.oecd.org/dataoecd/57/17/23435997.pdf

Nobody can know for sure if and when the rising costs will stop, there are those that say we are in a medical technology boom similar to what occurred during the industrial revolution and we will see costs rise for another 10-20 years and then stabilize. There is no definitive answer but what people agree on is that a universal system is able to control costs much better since it has the power to regulate prices. The US could do this by setting price ceilings on care but with our complex system and multitude of payers it would be extremely difficult to implement.

This book does a great job of covering this topic as well as conducting multivariate analysis on a cross-national basis.

Health Systems Performance Assessment: Debates, Methods, and Empiricism

There are also three other reasons to believe that a universal system does a better job of controlling costs

1. Cost effectiveness is tied to outcome.

2. We don't leverage our buying power. We pay top price for pharmaceuticals, subsidizing other countries treatment

3. Like I said earlier they create a budget ceiling, and try to make choices within that budget

Your idea that since those systems are complex and have shown that costs are rising they are not better than our systems is a cop out. I know about complex systems and I know about reform. However, you cannot let that fear paralyze you. When you have had 20 years of research show that these systems are better while at the same time show that our system is failing you must act. Nobody can know what will happen in the long term nobody is psychic but everyone agrees that the long term outlook for these systems is much better than the long term outlook for ours.

[PeterMP]

Yes health care has been increasing with inflation for around 2-3 decades now. This can be attributed to people's increased income, (with increase income comes a higher rate of spending on health), People getting older all over the world (older people require more care), and a boom in technology and pharmaceuticals.

http://www.oecd.org/dataoecd/57/17/23435997.pdf

I don't think that increased income is really an answer. I'd bet if you look at most things (homes, food, cars, entertainment), spending increases as a function of income longer term. Yet, nobody complains about those things, and for the most part, they aren't increasing at a rate faster than inflation (well, homes did for a while, but now they've come done considerably so net we are probably looking at something like inflation adjusted increases).

Nobody can know for sure if and when the rising costs will stop, there are those that say we are in a medical technology boom similar to what occurred during the industrial revolution and we will see costs rise for another 10-20 years and then stabilize. There is no definitive answer but what people agree on is that a universal system is able to control costs much better since it has the power to regulate prices. The US could do this by setting price ceilings on care but with our complex system and multitude of payers it would be extremely difficult to implement.

This is nonsense. There are plenty of examples where governments regulate things without a universal system. I've already explained what the Japanese do with respect to energy effeciency, and those aren't universal systems. Individual states regulate things like car insurance costs and energy costs without there being a universal systems. Our government regulates all sorts of emissions in a non-universal systems.

And if new law stays in place, we will have a universal system without getting rid of any of the layers of complexity so your arguement of universal vs. non-universal is complete garbage.

There are also three other reasons to believe that a universal system does a better job of controlling costs

1. Cost effectiveness is tied to outcome.

2. We don't leverage our buying power. We pay top price for pharmaceuticals, subsidizing other countries treatment

3. Like I said earlier they create a budget ceiling, and try to make choices within that budget

Again, complete garbage as the new law has given us a universal system without substantially changing any of those things. And we can do things about #2 without following countries down the same road.

Your framing arguments in the context of universal and non-universal that are completely independent of universal and non-universal.

Again, I'm not arguing that the European countries aren't currently doing a better job.

Your idea that since those systems are complex and have shown that costs are rising they are not better than our systems is a cop out. I know about complex systems and I know about reform. However, you cannot let that fear paralyze you.

This would be a valid argument if was arguing for paralysis, but since I'm not more garbage.

When you have had 20 years of research show that these systems are better while at the same time show that our system is failing you must act. Nobody can know what will happen in the long term nobody is psychic but everyone agrees that the long term outlook for these systems is much better than the long term outlook for ours.

Again, I'm not arguing for inaction.

The flip side of that is you have 20 years of research showing that they will eventually fail.

And it isn't about being a psychic. It is about looking at the evidence.

And you have again offered a false choice between what we are currently doing and what they are doing.

[shk75]

I don't think that increased income is really an answer. I'd bet if you look at most things (homes, food, cars, entertainment), spending increases as a function of income longer term. Yet, nobody complains about those things, and for the most part, they aren't increasing at a rate faster than inflation (well, homes did for a while, but now they've come done considerably so net we are probably looking at something like inflation adjusted increases).

This is nonsense. There are plenty of examples where governments regulate things without a universal system. I've already explained what the Japanese do with respect to energy effeciency, and those aren't universal systems. Individual states regulate things like car insurance costs and energy costs without there being a universal systems. Our government regulates all sorts of emissions in a non-universal systems.

And if new law stays in place, we will have a universal system without getting rid of any of the layers of complexity so your arguement of universal vs. non-universal is complete garbage.

Again, complete garbage as the new law has given us a universal system without substantially changing any of those things. And we can do things about #2 without following countries down the same road.

Your framing arguments in the context of universal and non-universal that are completely independent of universal and non-universal.

Again, I'm not arguing that the European countries aren't currently doing a better job.

This would be a valid argument if was arguing for paralysis, but since I'm not more garbage.

Again, I'm not arguing for inaction.

The flip side of that is you have 20 years of research showing that they will eventually fail.

And it isn't about being a psychic. It is about looking at the evidence.

And you have again offered a false choice between what we are currently doing and what they are doing.

OK Peter I am done here because you simply do not know what you are talking about. First you state that you do not think increased income is a reason why health care costs are skyrocketing. That is nice that you think that but you are wrong. EVERY SINGLE health care economist puts rising income as the number 1 or number 2 reason for rising health care costs. It is a pattern that has been seen time and time again and there is a rule that goes like this:

This FIRST thing that people purchase when their income rises is health care. This does not necessarily hold true on a person to person basis but on a population basis it is an undeniable fact.

Also to state there is 20 years of research that they will eventually fail is once again your opinion not a fact. I have not seen ONE study in any of my research that has said OECD models of universal care will fail in the future, not one. Once again you are just stating your opinion and not backing it with fact. Please show me a study that states that these systems will eventually fail.

[PeterMP]

Here's what to do about health care:

1. Cut the NIH budget and move those funds to other research initiatives. We aren't getting the bang our buck out of health care research. This isn't surprising when you look at how far we have come in that research compared to other fields like energy. Our dominant form of energy production hasn't substantially changed technology in over 100 years. The NIH research budget currently and for a long period of time is larger than all of the other non-military government research budgets combined (maybe even with the military because it is difficult to determine how much money the military really spends on research). This will increase our advances in other areas, which hopefully will drive costs down (e.g. energy costs will decrease) freeing up money for things like more advanced health care, while simultaneously slow down health care advances reducing the rate at which they are increasing and therefore increases in costs.

2 Refocus the remaining the NIH budget so that it emphasizes illnesses that will have substantial affects on extending the productive age of the recipetants of the resulting scientific discoveries (i.e. focus research on issues that kill/disable/reduce the life long productivity of young people) and carrying out the relevant studies over long periods of time. This way you will be more sure to get more bang for your buck in terms of real "gains" by the health care vs. extending somebody that is at a low productivity state life for 5 years, or things that are pretty much completely elective in nature that don't extend anybody's productivity. This also has the benefit that you are going to focus on "new" problems that are likely to have larger societal impacts largely as things like infectious disease changes and issues related to technological advances (e.g. pollution from new technologies (e.g. BPA)) normally greatly affect kids.

3. Change the patent laws and FDA approval process in a manner that will cause companies to do spend R&D money in a similar focus as the changes in NIH spending.

4. Make it clear to other countries that we are not going to continue to pay the disproportionate amount for innovation in health care. We are going to recoup those differences some how in a systematic manner directly related to the degree they put price controls on health care products/technology.

5. Create moving targets of effeciency based on the industry bests for health insurance, malpractice insurance, and actually providing health care. There are multiple ways to do this from out right requirements (like Japan does with energy and appliances) to more of a cap and trade approach. Force companies to look at what other companies are doing that is working and what they are doing that is working and not working and make changes. Those that won't change, go out of business.

6. Turn the CBO, GAO, or other similar organizations lose on the health care systems of other countries (if there is good existing research out there on this topic that makes their job easier). Determine the real costs of different systems and their rate of growth and those causes when introduced on the US population (and yes, the CBO does long term projections without claiming to be psychic).

[PeterMP]

OK Peter I am done here because you simply do not know what you are talking about. First you state that you do not think increased income is a reason why health care costs are skyrocketing. That is nice that you think that but you are wrong. EVERY SINGLE health care economist puts rising income as the number 1 or number 2 reason for rising health care costs. It is a pattern that has been seen time and time again and there is a rule that goes like this:

This FIRST thing that people purchase when their income rises is health care. This does not necessarily hold true on a person to person basis but on a population basis it is an undeniable fact.

Also to state there is 20 years of research that they will eventually fail is once again your opinion not a fact. I have not seen ONE study in any of my research that has said OECD models of universal care will fail in the future, not one. Once again you are just stating your opinion and not backing it with fact. Please show me a study that states that these systems will eventually fail.

Rising costs with rising income doesn't mean that things are rising faster than GDP. Those things go hand in hand. You failed to make that connection. Yes, health care costs are found to be a function of income and GDP, but that isn't really the issue. The issue is that health care costs are rising faster than those things. If our health care costs were rising as a simple (e.g. linear) function of income or GDP, we wouldn't have an issue (or at least not much of one).

If you back and look at the report I posted earlier (http://www.oecd.org/dataoecd/5/34/43800977.pdf), the have a graph of health care spending vs. GDP as a function of country (chart 3). If the graph of health care spending vs. GDP as a function of time (for any given country) looks that graph (taking out the US data point), then that country doesn't have much of an issue, but as far as I know that isn't the case for any western country.

Instead, the graphs look like this:

http://www.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/d/dc/Health_costs_USA_GDP.gif&imgrefurl=http://en.wikipedia.org/wiki/Health_care_in_the_United_States&usg=__SYTEQoCrKJRiQ1G-qrooV17LZTw=&h=474&w=300&sz=14&hl=en&start=0&zoom=1&tbnid=dj63FwZ5i_ZNpM:&tbnh=112&tbnw=71&prev=/images%3Fq%3D%2522united%2Bstates%2522%2BGDP%2Bhealth%2Bcare%2Bspending%2Bgraph%26hl%3Den%26safe%3Doff%26sa%3DX%26biw%3D993%26bih%3D493%26tbs%3Disch:1%26prmd%3Divns&itbs=1&iact=hc&vpx=357&vpy=22&dur=97&hovh=282&hovw=179&tx=100&ty=152&ei=6IYsTcbHB4G88gb02om0Cg&oei=6IYsTcbHB4G88gb02om0Cg&esq=1&page=1&ndsp=16&ved=1t:429,r:2,s:0

http://www.google.com/imgres?imgurl=http://www.kingsfund.org.uk/images/hi_res/2632_FAQs_5.jpg&imgrefurl=http://www.kingsfund.org.uk/current_projects/general_election_2010/frequently_asked.html&usg=__-T4-p6rFFQDZb6VKBdO42RREMB8=&h=419&w=490&sz=109&hl=en&start=0&zoom=1&tbnid=NN4xdr_bTmX1FM:&tbnh=114&tbnw=135&prev=/images%3Fq%3DEngland%2BGDP%2Bhealth%2Bcare%2Bspending%2Bgraph%26hl%3Den%26safe%3Doff%26biw%3D993%26bih%3D493%26tbs%3Disch:1&itbs=1&iact=hc&vpx=467&vpy=192&dur=4737&hovh=208&hovw=243&tx=128&ty=130&ei=P4csTcOWJYT48AaW0ZmxCg&oei=P4csTcOWJYT48AaW0ZmxCg&esq=1&page=1&ndsp=15&ved=1t:429,r:12,s:0

Where the axis is NOT just GPD, but percent of GDP.

(This is where if I'm misunderstanding your point, it would be nice if you'd actually give me something with a little context (rather than a whole book) to look at to understand your point. I'm not claiming to be the expert here. I'm not claiming there aren't things I don't know (I've already admitted that I don't know the details of several of the countries health care systems you have talked about), but from what I understand your statement doesn't make a lot sense, and simply saying all of the health care economists disagree with you (me), doesn't move the conversation much.)

All of the studies that show their costs are increasing faster than inflation without providing a mechanism by which that process is going to stop are evidence they are going to fail, but they might not fail. It is also possible that our health care system won't fail. Now, that isn't proof, and I've acknowledged the solution might lie in that direction. The thing is there are plenty of countries already searching in that direction, and if one of them finds it, then it will be easy to take their ideas and implement them here.

However, if you were looking for something, would you go and look in the area where multiple people have been looking for multiple decades without finding it (keeping in mind that they really have "hidden" help (from us in terms of paying the costs for innovation and technology), or would you say, I'm going to look over this direction and let them keep searching over there while keeping an eye on them.

[ABQCOWBOY]

Untrue. If you ask somebody about Obama care they crinkle there nose. But if you ask somebody about the features of the bill they like it.

It's not true the American people are unified agin it. Facts are. On the agin it arguement there are as many folks saying it doesn't go far enough as there are saying it goes too far.

Speculation on your part. I will assume that you have asked people in your geography if they like pieces of it or not and you base your answers on those discussions. I too have had discussions with people I associate with and have not come to the same conclusions. However, we can look at polls and see what they indicate. What they indicate is that Americans are falling away from this bill. Explain it however you like but at the end of the day, the support is not there. Without the support, the Law will fail IMO.

---------- Post added January-10th-2011 at 10:42 PM ----------

We already know what the GOP is offering. The 2006 unpaid for 900 billion dollar bush reform package. A joke. A huge check for the companies that are crushing us in exchange for a promise to go softer.

If this is true, then I imagine you have nothing to fear. However, if it is not, and I think this likely, then it would seem that you would at least have an interest in what exactly their position would entail. I have read in this thread that part of the problem we have with the Healthcare issue is that it is so big, it is almost impossible to fully understand all ramifications of it. I tend to agree with this yet in a few sentences, you have boiled down the entire GOP position on Healthcare and there plan to address it? Again, I am highly skeptical of this kind of rational.

[shk75]

Rising costs with rising income doesn't mean that things are rising faster than GDP. Those things go hand in hand. You failed to make that connection. Yes, health care costs are found to be a function of income and GDP, but that isn't really the issue. The issue is that health care costs are rising faster than those things. If our health care costs were rising as a simple (e.g. linear) function of income or GDP, we wouldn't have an issue (or at least not much of one).

Health care economists are not dumb. They would not say that increased income is a driver if the relationship were linear. The relationship is not linear. If a person making $20,000 spends $2,000 on health care and they get a raise to $40,000 dollars they will not spend $4,000 on health care but rather $5,000. The reason they believe this is occurring is because of what economists call utility. A person will move to maximize their utility and studies have shown that an increase in income leads to an even larger increase in health spending because it produces a better utility maximizing combination. This is why it is causing costs to grow at a rate faster than inflation. Also since health demand is an inelastic good and prices have increased at a rate higher than inflation, prices are a key factor as well and need to be lowered which is why I recommended that article "It's the Prices Stupid."

The reason I recommended you that book is because it is one of the best multivariate comparison analysis models made. It is very in depth and I have read it and no where does it suggest that the societal differences in the US would lead to universal care failing. I recommended it so you could look into it yourself since you do not seem to want to take my word for it. What people do confess is that if as a society Americans do not agree that health care is a basic human right and must be provided than reforms will not succeed.

[PeterMP]

Health care economists are not dumb. They would not say that increased income is a driver if the relationship were linear. The relationship is not linear. If a person making $20,000 spends $2,000 on health care and they get a raise to $40,000 dollars they will not spend $4,000 on health care but rather $5,000. The reason they believe this is occurring is because of what economists call utility. A person will move to maximize their utility and studies have shown that an increase in income leads to an even larger increase in health spending because it produces a better utility maximizing combination. This is why it is causing costs to grow at a rate faster than inflation. Also since health demand is an inelastic good and prices have increased at a rate higher than inflation, prices are a key factor as well and need to be lowered which is why I recommended that article "It's the Prices Stupid."

I don't doubt that there are smart health care economist, and I would presume it is like most professions and the most gifted rise to the top of the proffession.

I am a little dubious of people that claim to be experts, and then recite general political points that have largely been debunked for years (though it might not be an intelligence issue, but an issue with integrity/intellectual honesty).

So you're saying what I said must be happening (and gave graphs that showed it is happening) is in fact happening. That's great to know.

And your article doesn't mention utility, and none of the other countries we are talking about are actually lowering prices. I will point out though that even that isn't (much) of an issue on a population-wide basis IF as a function of income/GDP other variable raise more slowly than the income/GDP (they can increase just not at the same rate and must raise in a manner that is less than that of health care costs). But that doesn't even seem to be happening.

In many industries, including health care and entertainment, there hasn't been a TOTAL (various things might have decreased, but not across the board) decrease in costs associated with advances in technology, but instead there have been increases.

The reason I recommended you that book is because it is one of the best multivariate comparison analysis models made. It is very in depth and I have read it and no where does it suggest that the societal differences in the US would lead to universal care failing. I recommended it so you could look into it yourself since you do not seem to want to take my word for it. What people do confess is that if as a society Americans do not agree that health care is a basic human right and must be provided than reforms will not succeed.

Did they give you any reason to believe under such a system that the costs of care will stop increasing faster than the rate of GDP/income?

(Honestly, it doesn't really matter much. You can have a universal system that doesn't control costs well (like the one that the new law has given us), and you can have a non-universal system that does control costs well.)

[shk75]

Peter, you keep moving the goal posts. I prove one thing and then you jump to another. I cannot argue with you anymore because it is pointless.

[JMS]

Speculation on your part. I will assume that you have asked people in your geography if they like pieces of it or not and you base your answers on those discussions. I too have had discussions with people I associate with and have not come to the same conclusions. However, we can look at polls and see what they indicate. What they indicate is that Americans are falling away from this bill. Explain it however you like but at the end of the day, the support is not there. Without the support, the Law will fail IMO.

It's not speculation. It's called public opinion surveys. For every person against Obamacare because they say it goes to far; their is somebody who is against it because they claim it doesn't go far enough.

Voters who say the new health reform law was too conservative outnumber by 2 to 1 those supporting repeal, according to a poll released Saturday.

About 40 percent of respondents said the law was too timid in overhauling the nation's healthcare system, while 20 percent said they'd like to see it scrapped, according to the survey, commissioned by The Associated Press (AP).

http://thehill.com/blogs/blog-briefing-room/news/120915-poll-many-voters-think-health-reform-too-conservative

Likewise even those folks who are against it, if you talk about what is actually in the bill; they like the bills features when they hear them.

If this is true, then I imagine you have nothing to fear. However, if it is not, and I think this likely, then it would seem that you would at least have an interest in what exactly their position would entail. I have read in this thread that part of the problem we have with the Healthcare issue is that it is so big, it is almost impossible to fully understand all ramifications of it. I tend to agree with this yet in a few sentences, you have boiled down the entire GOP position on Healthcare and there plan to address it? Again, I am highly skeptical of this kind of rational.

:doh: What year is it? 2011? Why are you so shocked and offended when Bush's 2006 healthcare reform bill which he and the republicans passed into law; is held up as an example of Republican thinking on healthcare reform?

Hell yes that's exactly the kind of thinking that you can expect from the GOP on healthcare reform. Give 900 billion dollars to the healthcare industry; followed shortly their after by a hoard of congressmen and their staffers resigning office to go work for the healthcare companies which they just gifted the funds too. Exactly what they did in 2006; Wasn't that long ago.

[SnyderShrugged]

Peter, you keep moving the goal posts. I prove one thing and then you jump to another. I cannot argue with you anymore because it is pointless.

I thought he was asking very reasonable questions?

[PeterMP]

Peter, you keep moving the goal posts. I prove one thing and then you jump to another. I cannot argue with you anymore because it is pointless.

Any system that is likely to continue to have increases in costs faster than GDP/income is likely to fail. The question is directly related to your comment and not moving the goal posts.

[JMS]

What you mean the Dems had control of the Congress and White House and didn't ask the CBO or GAO to look at the real costs of adopting health care systems of different countries?

That's not even arguable. That's exactly what happenned. Obama did not consider a single payer system, he did not consider moving towards a known working model. He decided that was politically a non starter. Given the savage response to merely reforming the existinng broken system he recieved you would have to agree with him.

You're also offering the same false choice that shk75 did before. Do nothing or do something that we know is likely to fail based on what other countries have done.

Pete you are the only person on the planet who thinks that the entire industrialized world employs a healthcare system destined to fail. I don't know where you got that impression.

I also think it's unrealistic of you to imagine an ideal healthcare reform bill, then oppose any reform which does not fit into that abstract construction. The US healthcare system is in crisis; getting out of crisis should be a reasonable goal which every rational American can support. Even if some think it's just an interum goal.

I reject those choices.

Well pete I can see how you would. Considering we have seen in 2006 they type of reform the Republicans envision... Expensive, more debt, no real benifit to consumers. And in 2009 the type of reform the Democrats envisioned... ( deficit neutral, reforms with teeth for abusives, rights for consumers, 30-40 million more americans with coverage ).... I can see why you would want a nebulous fourth choice because the only sane choice before you is to support Obamacare and hope for the best.

(I do want to make the point. I'm trying not to fall into the argument of that perfect is the enemy of good. We are talking about health care systems that the countries that practice them openly admit are flawed, as far as I know. In addition, they have a pretty big negative in that they make the costs more abstract, and then less likely to REALLY be dealt with.

Again untrue. Canadians love their universal healthcare, so do the Japanese and Europeans. Is their room for improvement; sure; but those systems are not in crisis and they are offering services superior to our own system today.

I've written before. Some times when dealing with complex systems, a system that seems to be more stable at some point in time, longer term actually becomes the more unstable situation. This is especially true if they include processes that have to be reversed to reach a stable state that aren't easily reversed. I think heavy government involvement in covering the costs of healthcare might likely fall into this category.)

Problem with that analysis is it's been 4 decades since we've seen the upshot of these universal coverage healthcare systems. 4 decades of evidence. 4 decades of these systems outperforming our own.

We are the last country on earth to follow our model, we can hardley be framed as overly impulsive or irrationally trendy when the scope of all this evidence is measured.

---------- Post added January-11th-2011 at 02:13 PM ----------

Any system that is likely to continue to have increases in costs faster than GDP/income is likely to fail. The question is directly related to your comment and not moving the goal posts.

If those increases were constant you would be correct. But universal healthcare models implemented in the rest of the world are not facing constant increases. Our system is. It's we who have faced the higher healthcare expenses for 4 decades at tripple the rate of inflation; not the folks in the Universal systems who started out behind us and who now pay half of what we do or less for healthcare.

It's our distributed model which does not allow us to control healthcare expendatures. the Universal model which is much more consolidated is much better suited to hold down costs. The recent uptick in prices in these models reflects a concious decision by their leaders to increase and improve their systems; not a knee jerk repsonse to a fickle and ever exspanding healthcare black hole which catagorizes our own broken system.

[PeterMP]

Well pete I can see how you would. Considering we have seen in 2006 they type of reform the Republicans envision... Expensive, more debt, no real benifit to consumers. And in 2009 the type of reform the Democrats envisioned... ( deficit neutral, reforms with teeth for abusives, rights for consumers, 30-40 million more americans with coverage ).... I can see why you would want a nebulous fourth choice because the only sane choice before you is to support Obamacare and hope for the best.

Well, this could be an interesting discussion if EVER ONCE stated I was AT ALL against the law that passed or supported what was done in 2006.

(Actually, I probably have commented on it negatively in the context that it doesn't do enough to control costs, but I certainly haven't said I opposed it. Just very disappointed that more wasn't done to really control costs, but instead the emphasis was put on universality irregardless of costs.)

If those increases were constant you would be correct. But universal healthcare models implemented in the rest of the world are not facing constant increases. Our system is. It's we who have faced the higher healthcare expenses for 4 decades at tripple the rate of inflation; not the folks in the Universal systems who started out behind us and who now pay half of what we do or less for healthcare.

It's our distributed model which does not allow us to control healthcare expendatures. the Universal model which is much more consolidated is much better suited to hold down costs. The recent uptick in prices in these models reflects a concious decision by their leaders to increase and improve their systems; not a knee jerk repsonse to a fickle and ever exspanding healthcare black hole which catagorizes our own broken system.

1. Even shk75 admits that they have seen multi-decade increases in health care costs that have been faster than GDP and that it isn't clear when that will stop.

2. This would be a great point if I wasn't proposing we do things to control costs and continue with the status quo, but of course that's not the case:

http://www.extremeskins.com/showthread.php?342960-WP-CBO-says-health-care-repeal-would-deepen-deficit&p=8102719&viewfull=1#post8102719

[shk75]

Any system that is likely to continue to have increases in costs faster than GDP/income is likely to fail. The question is directly related to your comment and not moving the goal posts.

Ok, let me break it down for you one last time. Why have costs risen at a faster rate than GDP.

These are the three global trends that hold true for all systems.

1. Income has increased (I have already told you why this increases health spending disproportionately)

2. Technology is growing at a faster rate than GDP

3. The population is aging

In the US why are costs rising faster than other nations?

1. Prices are higher and rising at faster rates

2. Complexity of system and administrative costs

3. Vast variations in resource use without differences in quality of health outcomes

4. We use more emergency care

5. Insurance companies are run as for-profit

Now why has a universal system failed for points 1-3

1. Demand for price is inelastic but there is still a limit people are willing to pay. Moreover, if you set prices too low there is over-utilization of services and that is detrimental to the system and causes waiting lines and other issues in universal systems. Therefore they are in a kind of damned if you do damned if you don't situation. If they raise prices to high not everyone will have access and thus it will not be universal. If they set them too low there will be long waiting lines. Right now economists believe they are in an adjustment period where the market is looking to shift to a new equilibrium. Nobody knows exactly when or where that will be it could be 15% of GDP, 20%, 25% nobody knows and there are various projections. However a universal system can ultimately decide which of the two alternatives they want (more rationing of care or more waiting lines), the US as is currently operating does not have that power.

2. Medical technology is experiencing a boom like never before. New drugs, new machines, new procedures and they are all being touted as the best. Even nations with organizations that are responsible with evaluating new procedures and their cost-effectiveness (i.e. NICE) there is still new technology being introduced at a rate faster than ever before. This new technology is not cheap yet it saves lives and universal systems are having a tough time and are even being brought to court when they deny citizens access to theses treatments. However a universal system can ultimately decide to curb spending on technology or encourage low cost innovations like seen in Japan. In the US this does not happen, if hospitals and doctors pay for high price technology in order to impress their share holders the US cannot step in and say no you cannot buy this. In Europe many countries have global budgets and if as a hospital you overspend your budget you simply cannot buy anything else point blank.

3. People are getting older they are getting sicker, end of life care is expensive. This once again is occurring everywhere and in Europe they are constantly debating if an 85 year old with end stage renal disease should get state of the art treatment or not. This is where the death panel thing came in because sometimes in Europe these patients are not afforded the best care because the agencies in charge of approving them do not think they are cost-effective. People argue that this cost will stabilize since demographically the rate of increased like expectancy is not as fast is at was.

Now why would a universal system help alleviate the problems in the US

1. Prices would be controlled in order to control health care costs. You say this can be done without a universal system but you would agree that it would be a federal policy right? The federal government would have to set a price schedule for all procedures, drugs, etc. but it would not be universal care if not everyone is insured. It would be a federal policy to cap costs and impose price ceilings on medical care. Why not then just make sure everyone is insured and then bam, you have a bismarckian system of universal care.

2. Under a universal system there is one set of rules. Say goodbye to Medicare, Medicaid, SCHIP, HMO, PPO, Cobra, Cadillac plans, charity care, etc. There would be one system, now there can be as many private insurance companies as you like but they would be required to care for everyone and anyone who wants to sign up ,poor people, rich people, old people, young people, the chronically ill. There would not be separate plans for people from different groups but instead freedom of choice for consumers to sign up to any insurance plan they want.

3. One again the variations in care is related to the complexity of our system. Let's say for example Texas has low reimbursement rates for Medicaid but New York matches federal funds. Those in New York under Medicaid would have access to different kinds of care than those in Texas. Also let's say you run a private for-profit hospital in Michigan and you have to report to your share holders. The type of care you provide will be different than if you run a small non-profit hospital in Alabama. This is not to say that everyone must provide the same care everywhere but it is to say that in the US when profit enters as a motive many physicians and hospitals abuse this and this drives up health care costs.

4. We use more emergency care because people are not insured. This one is simple really if you insure more people and allow them to visit primary care doctors and receive yearly checkups it is less likely that they will use emergency care. Yes we also use more emergency care because we have more accidents and violent crimes but it is undeniable that emergency care would decrease if more people had access to primary care. A recent study showed that 90% of emergency rooms are providing preventive and primary care. This is simply unacceptable and is constraining their effectiveness and driving up costs since care in an ER is sometimes 4 times more than care in a physicians office.

5. I touched on this earlier but for-profit insurance drives up costs plain and simple. That is a reason why in universal systems costs are lower and rising at lower rates.

Now to sum up why can universal care help to control these costs, when you see that others are experiencing rising costs as well? It comes down to monopoly power. In these systems the sate regulates and sets the rules. That does not mean that they intervene or own everything, many systems, like the Swiss, are almost exclusively private. What it does mean is if there is a REAL crisis as in there is just no way we can keep spending what we are (which has not occurred yet, there is no REAL crisis yet just worrisome growth) the government can step in and control costs much easier than can be done in the US.

[PeterMP]

Ok, let me break it down for you one last time. Why have costs risen at a faster rate than GDP.

These are the three global trends that hold true for all systems.

1. Income has increased (I have already told you why this increases health spending disproportionately)

2. Technology is growing at a faster rate than GDP

3. The population is aging

In the US why are costs rising faster than other nations?

1. Prices are higher and rising at faster rates.

This isn't a cause of prices rising faster than other countries.

2. Complexity of system and administrative costs.

This doesn't explain faster increases in prices unless complexity is also rising at a faster rate, which I've never seen any evidence for. This does greatly affect the base line costs, and isn't tied to universal vs. non-universal as the new law won't greatly affect this.

3. Vast variations in resource use without differences in quality of health outcomes

This has nothing to do with universal vs. non-universal. For example, the new law will not greatly affect this.

4. We use more emergency care

This is most likely false and tied to the idea that we will save money through preventative care.

5. Insurance companies are run as for-profit.

Again, this has nothing to do with uinversal vs. non-universal.

1. Demand for price is inelastic but there is still a limit people are willing to pay. Moreover, if you set prices too low there is over-utilization of services and that is detrimental to the system and causes waiting lines and other issues in universal systems. Therefore they are in a kind of damned if you do damned if you don't situation. If they raise prices to high not everyone will have access and thus it will not be universal. If they set them too low there will be long waiting lines. Right now economists believe they are in an adjustment period where the market is looking to shift to a new equilibrium. Nobody knows exactly when or where that will be it could be 15% of GDP, 20%, 25% nobody knows and there are various projections. However a universal system can ultimately decide which of the two alternatives they want (more rationing of care or more waiting lines), the US as is currently operating does not have that power.

Has nothing to do with universal and non-universal.

2. Medical technology is experiencing a boom like never before. New drugs, new machines, new procedures and they are all being touted as the best. Even nations with organizations that are responsible with evaluating new procedures and their cost-effectiveness (i.e. NICE) there is still new technology being introduced at a rate faster than ever before. This new technology is not cheap yet it saves lives and universal systems are having a tough time and are even being brought to court when they deny citizens access to theses treatments. However a universal system can ultimately decide to curb spending on technology or encourage low cost innovations like seen in Japan. In the US this does not happen, if hospitals and doctors pay for high price technology in order to impress their share holders the US cannot step in and say no you cannot buy this. In Europe many countries have global budgets and if as a hospital you overspend your budget you simply cannot buy anything else point blank.

1. This has nothing to do with universal and non-universal.

2. This is false. You can see the CBO report I linked earlier in this thread with respect to Pharmaceutical R&D.

3. People are getting older they are getting sicker, end of life care is expensive. This once again is occurring everywhere and in Europe they are constantly debating if an 85 year old with end stage renal disease should get state of the art treatment or not. This is where the death panel thing came in because sometimes in Europe these patients are not afforded the best care because the agencies in charge of approving them do not think they are cost-effective. People argue that this cost will stabilize since demographically the rate of increased like expectancy is not as fast is at was.

Of course that assumes that it will happen.

Now why would a universal system help alleviate the problems in the US

1. Prices would be controlled in order to control health care costs. You say this can be done without a universal system but you would agree that it would be a federal policy right? The federal government would have to set a price schedule for all procedures, drugs, etc. but it would not be universal care if not everyone is insured. It would be a federal policy to cap costs and impose price ceilings on medical care. Why not then just make sure everyone is insured and then bam, you have a bismarckian system of universal care.

There are various ways this could be done without setting a hard ceiling on prices. You could use the equivalent of a cap and trade solutions that have been done for emissions.

Why do it?

2. Under a universal system there is one set of rules. Say goodbye to Medicare, Medicaid, SCHIP, HMO, PPO, Cobra, Cadillac plans, charity care, etc. There would be one system, now there can be as many private insurance companies as you like but they would be required to care for everyone and anyone who wants to sign up ,poor people, rich people, old people, young people, the chronically ill. There would not be separate plans for people from different groups but instead freedom of choice for consumers to sign up to any insurance plan they want.

1. Not true. The new law created a universal system without doing away with any of these things.

2. Is there a technical difference than if I have different plans for different groups vs. different plans and people chose to put themself in a particular plan (which essentially puts them in a group (the group that choose that plan))?

3. One again the variations in care is related to the complexity of our system. Let's say for example Texas has low reimbursement rates for Medicaid but New York matches federal funds. Those in New York under Medicaid would have access to different kinds of care than those in Texas. Also let's say you run a private for-profit hospital in Michigan and you have to report to your share holders. The type of care you provide will be different than if you run a small non-profit hospital in Alabama. This is not to say that everyone must provide the same care everywhere but it is to say that in the US when profit enters as a motive many physicians and hospitals abuse this and this drives up health care costs.

I'm not at all sure why this is relevant.

4. We use more emergency care because people are not insured. This one is simple really if you insure more people and allow them to visit primary care doctors and receive yearly checkups it is less likely that they will use emergency care. Yes we also use more emergency care because we have more accidents and violent crimes but it is undeniable that emergency care would decrease if more people had access to primary care. A recent study showed that 90% of emergency rooms are providing preventive and primary care. This is simply unacceptable and is constraining their effectiveness and driving up costs since care in an ER is sometimes 4 times more than care in a physicians office.

I can post the link from the NEJM on preventative care not saving money again if you'd like.

5. I touched on this earlier but for-profit insurance drives up costs plain and simple. That is a reason why in universal systems costs are lower and rising at lower rates.

Again, nothing to do with universal and non-universal.

Are health insurance company profits rising at a rate faster than GDP/income?

[shk75]

AHHH Peter I am done. You have single-handily proven why the lay person does not understand the issue. It really is disgusting too because people will read this and think you know what you are talking about when you have no idea. I am not going to go point by point and tell you why are so wrong because it will take too long and I just do not have the time for this anymore. The point is you do not understand any of the points I have made and I can tell you do not understand based on your ridiculous replies. But yes you are right you know more than I do about health care and reform.

[SnyderShrugged]

AHHH Peter I am done. You have single-handily proven why the lay person does not understand the issue. It really is disgusting too because people will read this and think you know what you are talking about when you have no idea. I am not going to go point by point and tell you why are so wrong because it will take too long and I just do not have the time for this anymore. The point is you do not understand any of the points I have made and I can tell you do not understand based on your ridiculous replies. But yes you are right you know more than I do about health care and reform.

thats weak sauce. If you can disprove his points, then do so.

[shk75]

thats weak sauce. If you can disprove his points, then do so.

I have but you see his rebuttals are this is not true lol. Anyone can do that. The sky is blue, this is not true oh ok.

[SnyderShrugged]

I have but you see his rebuttals are this is not true lol. Anyone can do that. The sky is blue, this is not true oh ok.

maybe you should back up the "truth" with solid data instead?